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What is a Medicaid Waiver?For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

This is a Medicaid program for elderly and / or disabled Tennessee residents that require the level of care typically provided in a nursing home but have elected to receive care outside of that environment either in their home, the home of a caregiver or in as assisted living community. A wide range of personal care assistance and support services are covered by this program targeting both the person in need of assistance as well as their primary caregivers. Most relevantly is personal care provide at home, in adult day care or in assisted living residences. Also of great interest is the support of assistive technology, personal emergency response services and minor home modifications to make a home safer and more accessible.

Under CHOICES, the adult children of aging parents can be paid to be caregivers.

The word CHOICES in the program's name stems from the fact that some of the services can be “consumer directed”. This means they are offered based on the Medicaid Cash and Counseling model in which participants are provided with the flexibility and choice to self-select their care providers. One service which is very popular for self-direction is personal care as friends, neighbors and certain family members can be hired to provide this type of care. Family members, with the exception of spouses and legal guardians, can be paid to be caregivers.

Terminology - There is considerable confusion surrounding this program due to name changes. This is a Medicaid program which in Tennessee is called TennCare. It falls under the Division of Long-Term Services & Supports, which was formerly called simply "Long Term Care". The program CHOICES now encompasses a previous Medicaid Waiver which was called the Elderly and Disabled Home and Community Based Services (E&D HCBS) Waiver.

Eligibility Guidelines

This program has qualification criteria regarding the applicant's age, functional ability and financial situation. Applicants must be disabled and at least 21 years of age. If they are 65 or older, full disability is not required, instead they require the level of care typically provided in nursing homes.

Financially, applicants must qualify for Tennessee Medicaid's long term care services. To do so, there are income and assets restrictions. The 2014 income limit for an individual applicant is $2,163 / month. The asset limit is $2,000 in countable assets. This excludes certain resources like pre-paid burial plans, wedding rings and one's home and vehicle.

Applicant's over these limits may still qualify if they are married and their spouse is not applying. Under these circumstances, a portion of their joint income and resources can be put in the spouse's name to enable him or her to live independently. In 2014, the non-applicant spouse can have $2,931 / month in income and up to $117,240 in countable assets. Re-allocation can effectively lower the applicant's income and assets to an acceptable level.

Another alternative is to distribute excess income into a pooled or Miller Trust. This also can effectively lower income to the eligibility limit. Some excess resources can be converted to non-countable assets. This process is called Medicaid planning. One can learn more here.

Benefits and Services

This program provides services that help individuals remain living outside of nursing homes. Some of these services can be self-directed.

Adult day care

Assisted living

Assistive technology and home modifications to make one's residence more accessible

Home-delivered meals

Homemaker services assistance with the instrumental activities of daily living)

Personal care assistance with the activities of daily living sometimes also called attendant care

Personal Emergency Response services or PERS

Respite care for the primary caregiver

Rodent and insect control

How to Apply / Learn More

Interested individuals should contact their local Area Agency on Aging or visit the TennCare Choice website to learn more about the program. Alternatively, one can call their toll-free number at 1-866-836-6678.

The CHOICES program is available statewide however a waiting list for services may exist and prioritization is not necessarily first come, first serve. Persons who are currently residing in a nursing home and wish to return home may receive priority.

Did You Know? Free assistance is available to Tennessee seniors to help them find affordable home care, Alzheimer's care and assisted living. Get help here.